I was struck by this sentence in a report on research with women aged 45 to 65 experiencing menopause: “As a generation, they have yet to develop a voice for this situation, and many remain silent rather than proactively seeing help.”

Really? We are the generation who, in high school, bought Our Bodies, Ourselves to better understand menstruation and sex. We pushed the boundaries to study science, go to medical school, become executives, compete for construction jobs, run our own businesses. We bought Marlo Thomas’s “Free to Be You and Me” for our kids.

But in my own experience as a physician, I see evidence that it’s true. When my practice included women of all ages, patients came in ready to talk in detail about physical symptoms—and emotional effects—related to pregnancy or fertility or uncooperative or uncomfortable periods. I don’t recall as many conversations about symptoms of menopause, especially as they related to sexuality.

In the last few years, since I’ve focused my practice on mid-life women, those who come to see me are ready to talk. This may have encouraged me to think we’ve made more progress than we have; this “REVEAL” (Revealing Vaginal Effecs at Mid-Life) study is a useful reality check. This research found that 41 percent of postmenopausal women had not talked to anyone about their sexual health in the previous year. Just over a third had talked to a health care provider; fewer—30 percent—had spoken to their partner or significant other.

The oldest women in the study—60 to 65—were least likely to have spoken to anyone at all. The younger women—45 to 49—were more likely to have spoken to someone: health care providers, partners, and then female friends.

Why does any of this matter? Consider the other findings of this research:

While almost all of the women surveyed were familiar with hot flashes as a symptom of menopause, fewer than half were aware that vulvar/vaginal pain was another symptom.

A quarter of those surveyed experienced pain during sex; most of those women still have sex—in spite of the discomfort—at least once a month.

The majority—80 percent—of the women who experienced pain during sex assumed it was a “normal part of getting older.”

That’s a whole lot of women who aren’t aware that sex can still be pleasurable and pain-free, even after menopause. And it’s a whole lot of women who won’t even broach the topic with their health care providers, because they assume that nothing can be done.

So! Clearly, it’s up to you! I imagine a whole lot of conversations between best women friends, women and their partners, sisters… and, for the sake of the next generation, between us and our daughters.

There are symptoms of menopause beyond hot flashes, night sweats, and mood swings. Decreasing hormone levels affect our vaginal and genital tissues, but they don’t spell the end of sexuality—or comfortable intercourse. There are things any woman can do to restore or preserve her sexual health, and we need to talk about them!